OBJECTIVES: Mammography screening programs (MSPs) aim to reduce breast cancer mortality by detecting tumors at early stages, when treatment is more effective. The "donna" MSP was introduced in 2010 in the canton of St. Gallen in Switzerland and utilizes mammography screening to detect breast cancer in women aged 50 to 69 years. With this study, we aim at conducting a cost-effectiveness analysis to evaluate the economic and health outcomes of the "donna" MSP.

METHODS: A decision-analytic Markov model with a 10-year time span is developed. The natural history of breast cancer according to tumor stage at detection is simulated and costs and health outcomes associated with the MSP in the canton of St. Gallen are assessed in comparison to no MSP in the canton of Zürich. The Swiss payer cost perspective is adopted, with cost data derived from one of the main Swiss health insurances. Information on mammography sensitivity and specificity, breast cancer incidence, progression, recurrence and mortality rates, as well as tumor stages distribution is derived from the cantonal cancer registries. Quality of life estimates are derived from the literature. Cost-effectiveness will be evaluated using incremental cost-effectiveness ratios and willingness-to-pay thresholds. Sensitivity analyses will be conducted to test the robustness of the results.

RESULTS: Expected results are that the “donna" MSP is associated with increased costs compared to no MSP but also leads to improvements in health outcomes. Preliminary results show that this effect is likely to be driven by the more favorable tumor stages distribution associated with the MSP. This might suggest that the "donna" MSP is likely to be cost-effective compared to no MSP.

CONCLUSIONS: Our results will provide evidence to support the implementation of a MSP in other Swiss cantons, as well as in other comparable countries where such a program has not been implemented yet.